Rural areas brace for shortage of doctors after changes in visa policy

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In Coudersport, Pennsylvania, a town in a mountainous region an hour's drive from the nearest Wal-Mart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.

In Fargo, North Dakota, a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.

In Great Falls, Montana, 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.

Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents' medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.

While the Trump administration is fighting, in the courts of justice and public opinion, for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.

In Montana, for example, where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.

"Our health system already has nine months invested in her, and now we have no idea when she can start," said Erica Martin, who recruits doctors for the company.

The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo.

"I won't have an income, I don't know if I will afford rent, I don't know where I will be," she said. "It's insane."

The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced that it would temporarily suspend a "premium processing" option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee.

A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to "work down the existing backlogs due to the high volume of incoming petitions."

The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.

H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.

About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.

There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.

Sens. Amy Klobuchar, D-Minn.; Susan M. Collins, R-Maine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.

"Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America," Heitkamp wrote in an email.

The delay also could affect the roughly 400 foreign medical graduates who come each year to participate in residency programs at teaching hospitals. The doctors were matched Friday for residencies starting July 1 across the country.

"Everyone around the country will be in a mad scramble to figure out this visa situation," said Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, which usually takes 10 or 12 residents on H-1Bs each year at its Anschutz Medical Campus.

The immigration agency said in a statement that applicants could still request an H-1B approval on an "expedited basis," if they could prove there was an emergency or humanitarian justification.

Immigration lawyers said that it was extremely difficult to meet that standard, and that they doubted whether the agency could handle a flood of such requests.

"If they don't have the manpower to do premium processing, I don't see how they are going to do special requests," said Andrea Szew, a lawyer in Los Angeles.


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